Stent grafts and methods of use for treating aneurysms

ABSTRACT

A stent graft includes a tubular aortic component that defines a lumen and a fenestration with a pocket at the fenestration. At least one proximal tunnel graft extends proximally within the lumen from the proximal opening of the pocket and is secured at a proximal end to the tubular component, and at least one distal tunnel graft extends distally within the lumen from the distal opening of the pocket and is secured at a distal end to the tubular aortic component. The stent graft can further include at least one branch stent graft, each of which extends through the fenestration and within at least one of the proximal tunnel graft or the distal tunnel graft. The stent graft can be implanted in a patient to thereby treat an aneurysm, such as a suprarenal or thoracoabdominal aortic aneurysm.

RELATED APPLICATION

This application claims the benefit of U.S. Provisional Application No.62/341,234. filed on May 25, 2016. The entire teachings of the aboveapplication are incorporated herein by reference.

BACKGROUND

Suprarenal abdominal aortic aneurysms (AAA) and thoracoabdominal aorticaneurysms (TAAA) are life-threatening conditions that represent surgicalchallenges. Although open surgical repair of these aneurysms can treatthe diseased area of the aorta, there are considerable risks with openrepair, primarily as a consequence of ischemic insult to the spinalcord, kidneys and surrounding abdominal viscera resulting from surgery.Currently, open surgical techniques to repair suprarenal AAA and TAAAinclude distal aortic perfusion via extracorporeal circuits, in-lineshunts, and cold renal perfusion to reduce the potential of ischemicinjury to the spinal cord and renovisceral areas.

Therefore, a need exits for new and improved endovascular repair devicesand methods to treat suprarenal AAA and TAAA that minimize trauma to thepatient, and loss of blood flow to the spinal cord and surroundingviscera.

SUMMARY OF THE INVENTION

The present invention relates to stent grafts and methods of using stentgrafts to treat aortic vascular damage, such as vascular damageassociated with suprarenal AAA and TAAA, including aneurysms,penetrating ulcers and dissection.

In an embodiment, the invention is a stent graft comprising: a tubularaortic component defining a lumen having a proximal end, a distal end, amajor longitudinal axis, and defining a fenestration between theproximal end and the distal end; a pocket at the fenestration, thepocket defining a pocket proximal opening and a pocket distal openingopposite the pocket proximal opening within the lumen; at least oneproximal tunnel graft having a proximal tunnel graft proximal end, andat least one proximal tunnel graft distal end, and defining a proximaltunnel graft lumen, the proximal tunnel graft extending proximallywithin the lumen from the pocket proximal opening and being secured atits proximal end to the tubular aortic component; and at least onedistal tunnel graft having a distal tunnel graft proximal end and adistal tunnel graft distal end, and defining at least one distal tunnelgraft lumen, the distal tunnel graft extending distally within the lumenfrom the distal opening of the pocket and being secured at its distalend to the tubular aortic component.

In another embodiment, the invention is a method for treating asuprarenal or a thoracoabdominal aortic aneurysm. A stent graft isdelivered through an aorta to an aneurysm site of a patient, the stentgraft being radially and releasably constrained by a distal end of acontrol catheter of a delivery device. The stent graft includes: atubular aortic component defining a lumen having a proximal end, adistal end, a major longitudinal axis, and defining a fenestrationbetween the proximal end and the distal end; a pocket at thefenestration, the pocket defining a proximal opening and a distalopening opposite the proximal opening within the lumen; at least oneproximal tunnel graft having a proximal tunnel graft proximal end and aproximal tunnel graft distal end, and defining at least one proximaltunnel graft lumen, the proximal tunnel graft extending proximallywithin the lumen from the proximal opening of the pocket and beingsecured at its proximal end to the tubular aortic component; and atleast one distal tunnel graft having a distal tunnel graft proximal endand a distal tunnel graft distal end, and defining at least one distaltunnel graft lumen, the distal tunnel graft extending distally withinthe lumen from the distal opening of the pocket and being secured at itsdistal end to the tubular aortic component. The fenestration is alignedat the aneurysm site of the patient with at least one branch of theaorta at the aneurysm site. The tubular aortic component (stent graft)is released from the delivery device, such as by retracting a controlcatheter of the delivery device. Each of at least one branch stent graftis delivered through the distal end and the proximal end of the stentgraft and through the distal tunnel graft or the proximal tunnel graftto the fenestration, and through the fenestration to a branch of theaorta at the aneurysm site of the patient, whereby the branch stentgraft is secured into the distal tunnel graft lumen or the proximaltunnel graft lumen while being radially constrained at the opposite endof the branch stent graft by a branch delivery device. Each branch stentgraft is released from the branch delivery device to thereby completeimplantation of the branch stent graft and treat the suprarenal orthoracoabdominal aortic aneurysm.

The stent grafts and methods of the invention have several advantages,including, for example, defining a fenestration that reduces the profileof the stent graft which, in turn, has the advantage of accommodatingbranch stent grafts within tunnel grafts to minimize the diameter of aprosthesis placed in a diseased aorta. The length and diameter of thefenestration can be customized for individual patients depending uponthe degree and extent of the suprarenal AAA and TAAA to permit thesurgeon to minimize trauma in the area of the diseased aorta whileproviding the surgeon with a decreased profile for introducing branchstent grafts to branch vessels of organs and tissues in the area of thediseased aorta.

The stent grafts and methods of the invention also have the advantage ofproviding greater flexibility of choice to the surgeon introducingbranch stent grafts, arranging them in either an antegrade or retrogradeconfiguration, to accommodate the anatomical features specific to tissuesurrounding the aneurysm. In the case of arteries, antegrade is the flowof blood away from the heart and in the case of veins antegrade is theflow of blood towards the heart. In the case of arteries, retrograde isthe flow of blood towards the heart and in the case of veins retrogradeis the flood of blood away from the heart. For example, antegradeplacement of a branch stent graft in an aorta refers to the implantationof a branch stent graft that results in a portion of the branch stentgraft extending from the fenestration in the tubular aortic component(stent graft with fenestration implanted in the aorta at the site of ananeurysm) in the same direction as the flow of blood. In contrast,retrograde placement of a branch stent graft in an aorta refers to theimplantation of a branch stent graft that results in a portion of thebranch stent graft extending from the fenestration in the aortic stentgraft component in a direction that is opposite the flow of blood fromthe heart.

Further, the proximal and distal tunnel grafts are each secured to theaortic graft component at their proximal and distal ends, respectively.As a result, implantation of branch stent grafts which, in abdominalaortic aneurysms or thoracoabdominal aortic aneurysm surgeries, must bethrough either the proximal or distal end of the aortic stent graftcomponent, is facilitated by relatively stable positioning of theproximal end of the proximal tunnel graft and the distal end of thedistal tunnel graft within the aortic stent graft component.

BRIEF DESCRIPTION OF THE DRAWINGS

The foregoing will be apparent from the following more particulardescription of example embodiments of the invention, as illustrated inthe accompanying drawings in which like reference characters refer tothe same parts throughout the different views. The same number indifferent drawings represents the same item. The drawings are notnecessarily to scale, emphasis instead being placed upon illustratingembodiments of the present invention.

FIG. 1 is a side view of one embodiment of a stent graft of theinvention.

FIG. 2A is a side view of another embodiment of a stent graft of theinvention, like that of FIG. 1 but lacking a distal bare stent androtated 90° about a major longitudinal axis.

FIG. 2B is a side view of the embodiment of FIG. 2A showing, indashed-lines, a pocket and tunnel grafts within an aortic stentcomponent of the invention.

FIG. 3A is a side view of another embodiment of a stent graft of theinvention, wherein the proximal end of a proximal tunnel graft and adistal end of a distal tunnel graft of the embodiment are flared.

FIG. 3B is a side view of the embodiment of FIG. 3A rotated 90° about amajor axis of the stent graft of the invention.

FIG. 4A is a side view of yet another embodiment of a stent graft of theinvention after implantation at an aneurysm site in a subject, whereinthe distal end of the aortic graft component is bifurcated.

FIG. 4B is a cross-sectional view of the embodiment of the stent graftof the invention shown in FIG. 4A taken along line 4B-4B therein, andshowing an end view of the proximal tunnel graft of FIG. 4A.

FIG. 5 is a side view of the stent graft of the invention of FIGS. 4Aand 4B, and further including two branch stent grafts extending from thefenestration of the tubular aortic component of the invention afterimplantation at an aneurysm site in a subject.

FIG. 6A is a side view of another embodiment of a stent graft of theinvention, having a bifurcated distal end, and wherein the proximal anddistal tunnel grafts are partitioned into sublumens, as shown afterimplantation at an aneurysm site in a subject.

FIG. 6B is a cross sectional view of the embodiment of the stent graftof the invention shown in FIG. 6A taken along line 6B-6B therein, andshowing an end view of the sublumens of proximal tunnel graft of FIG.6A.

FIG. 7 is a side view of the stent graft of the invention of FIGS. 6Aand 6B, and further including four branch stent grafts extending from afenestration of a tubular aortic component of the invention afterimplantation at an aneurysm site of a subject.

DETAILED DESCRIPTION OF THE INVENTION

The invention is generally directed to prostheses for use in treatingvascular disease, such as implantation of the prostheses at a site of anaortic aneurysm.

The features and other details of the invention, either as steps of theinvention or as combinations of parts of the invention will now be moreparticularly described and pointed out in the claims. It will beunderstood that the particular embodiments of the invention are shown byway of illustration and not as limitations of the invention. Theprinciple features of this invention can be employed in variousembodiments without departing from the scope of the invention.

A description of example embodiments of the invention follows.

When reference is made herein to a prosthesis to be delivered, orimplanted in a patient, such as a vascular repair device, the word“proximal” means that portion of the prosthesis or component of theprosthesis that is relatively close to the heart of the patient and“distal” means that portion of the prosthesis or component of theprosthesis that is relatively far from the heart of the patient.

When, however, reference is made to a delivery system or a component ofa delivery system employed to deliver, or implant a vascular repairdevice, the word, “proximal,” as employed herein, means closer to theclinician using the delivery system. “Distal,” as that term is employedherein, means, when reference is made to a delivery system or acomponent of a delivery system, further away from the clinician usingthe delivery system.

For clarity, the word “proximate” means “close to,” as opposed to themeanings ascribed to “proximal” or “distal” above with respect to eitherthe vascular repair device or delivery system.

One embodiment of the stent graft of the invention is shown in FIG. 1.As shown therein, stent graft (10) includes tubular aortic component(12) defining a lumen having proximal end (14), distal end (16), majorlongitudinal axis (18), and defining fenestration (20) between proximalend (14) and distal end (16) of stent graft (10). Tubular aorticcomponent (12) is made from suitable materials, such as are known tothose skilled in the art, including, for example, expandedpolytetrafluoroethylene (PTFE), such as expanded PTFE (ePTFE), andpolyethylene terephthalate (PET), such as woven polyester. Fenestration(20) defines fenestration proximal end (22) and fenestration distal end(24). Stents (26) extend about at least a portion of the circumferenceof tubular aortic component (12) between proximal end (14) and distalend (16). Proximal bare stent (28) and distal bare stent (30) aresecured to proximal end (14) and distal end (16), respectively. Stents(26) and bare stents (28, 30) are sutured to tubular aortic component(12) by suitable means known to those skilled in the art, such as bysutures (31), including sutures fabricated of polyester ePTFE (expandedpolytetrafluoroethylene), polyglycolic acid, polylactic acid, monocryland polydioxanone, non-absorbable nylon, polyester, PVDF (polyvinylidenedifluoride) and polypropylene. Stents (26) and bare stents (28, 30) areformed of a suitable material, such as is known to those skilled in theart, including nitinol. Suitable radiographic markers (32), such as areknown to those skilled in the art, are sutured to periphery (34) offenestration (20).

FIG. 2A is a side view of another embodiment of the invention. Therein,stent graft 36 is like that of FIG. 1, but, as shown, is rotated 90°about major longitudinal axis (18) and lacks distal bare stent (30).FIG. 2B is a side view of the embodiment of the invention shown in FIG.2A and shows components of the invention in outline (dashed-lines) thatare within the lumen defined by tubular aortic component (12).Specifically, stent graft (36) includes pocket (38) at fenestration(20). Pocket (38) defines pocket proximal opening (40) and pocket distalopening (42) opposite pocket proximal opening (40). Pocket proximalopening (40) of pocket (38) lies in plane A that is located proximallyto proximal end (22) of fenestration (20). Pocket distal opening (42)lies in plane B located distally from distal end (24) of fenestration(20). As also shown in FIG. 2B, fenestration proximal end (22) lies inplane C, and fenestration distal end (24) lies in a plane D. Both planeC and plane D are essentially orthogonal to major longitudinal axis (18)of tubular aortic component (12). Plane A is parallel to and locatedproximal to plane C, and plane B is parallel to and lies distal to planeD.

Proximal tunnel graft (44) of stent graft (36) has proximal tunnel graftproximal end (46), proximal tunnel graft distal end (48) and proximaltunnel graft lumen (50). Proximal tunnel graft (44) extends proximallywithin the lumen of tubular aortic component (12) from pocket proximalopening (40) and is secured to proximal opening (40). Stent graft (36)also includes distal tunnel graft (52) having distal tunnel graftproximal end (54), distal tunnel graft distal end (56) and distal tunnelgraft lumen (58). Distal tunnel graft (52) extends distally within thelumen of tubular aortic component (12) from pocket distal opening (42)and is secured to distal pocket opening (42).

At least one of proximal tunnel graft (44) and distal tunnel graft (52)is secured to an interior of tubular aorta component (12) by a suitabletechnique, such as is known to one skilled in the art, such as by asuture or biocompatible adhesive. For example, in one embodiment,proximal end (46) of proximal tunnel graft (44) is fixed to tubularaortic component (12) by proximal suture (60), and distal end (56) ofdistal tunnel graft (52) is fixed to tubular aortic component (12) bydistal suture (61). Alternatively, at least one of proximal tunnel graft(44) and distal tunnel graft (52) can be attached to tubular aorticcomponent (12) by more than a single suture, such as along anintermittent or continuous length (not shown), over a portion or theentire length of proximal tunnel graft (44) and distal tunnel graft(52), respectively.

FIG. 3A is a side view of another embodiment of a stent graft of theinvention. As shown therein, stent graft (62) is like that of FIGS. 2Aand 2B, except that stent graft (62) includes proximal tunnel graft (64)having proximal tunnel graft proximal end (66) that is flared. Proximaltunnel graft (64) includes proximal tunnel graft stents (68) and stentgraft (62) also includes distal tunnel graft (70) having distal tunnelgraft distal end (56) that is flared. FIG. 3B is a side view of tunnelgraft (62) but rotated 90° about axis (18). At least one stent (67, 77),supports the flared opening of at least one of proximal end (66) anddistal end (72), respectively. Flared proximal tunnel graft proximal endopening (66) of proximal tunnel graft (64) and flared distal tunnelgraft distal end opening (72) of distal tunnel graft (70), respectively,provides guidance to the surgeon during placement of a branch stentgraft into a respective tunnel graft. In one embodiment, at least one offenestration proximal end (22) and fenestration distal end (24) offenestration (20) lies in plane C, D, respectively, orthogonal to majorlongitudinal axis (18) and has a length, L, shown in FIG. 3B. Length Lis greater than the diameter of distal end (76) of the at least oneproximal tunnel graft (64) or proximal end (78) of distal tunnel graft(70) extending from the respective proximal opening (40) and distalopening (42) of pocket (38).

FIG. 4A is a side view of another embodiment of a stent graft of theinvention. Stent graft (80) is like that of stent graft (62) in FIGS. 3Aand 3B, but includes bifurcated distal end (82). FIG. 4B is across-sectional view of stent graft 80 taken along line 4B-4B, of FIG.4A. As shown in FIG. 4B, length L of the diameter of fenestration (20)is greater than that of diameter D of proximal tunnel graft (64) atproximal tunnel graft distal end (48). As shown in FIG. 5, stent graft(80) is implanted in abdominal aortic aneurysm (84) of a subject, andfurther includes branch stent grafts (86, 88), each implanted in a renalartery (90, 92), respectively.

FIG. 6A is a side view of yet another embodiment of the stent graft ofthe invention. As shown therein, stent graft (100) is like stent graft(80) of FIGS. 4A, 4B and 5, but includes partitioned proximal tunnelgraft (102) and partitioned distal tunnel graft (104). It is to beunderstood, however, that alternative embodiments are also possible,wherein only one or the other of proximal tunnel graft (102) or distaltunnel graft (104) is bifurcated. Septums (106, 108) partition each ofthe respective proximal and distal tunnel graft lumens (102, 104) intotwo proximal sublumens (110, 112) and distal sublumens (114, 116).Septums (106, 108) partition each of the respective proximal and distaltunnel graft lumens (102, 104) into two sublumens, to a point proximalor distal to openings of the respective tunnel graft lumens. Eachsublumen has a sublumen proximal end and sublumen distal end,respectively. As shown in FIG. 6B, which is a cross-sectional view ofstent graft 100 taken along line 6B-6B, proximal tunnel graft septum(106) can be formed by, for example, stitching proximal tunnel graft(102) along a center line to tubular aortic graft component (12) bystitching (118). It is to be understood that other methods of formingsublumens, such as are known in the art, can be employed in thealternative. For example, two parallel proximal or distal tunnel graftscan be employed instead of proximal and distal tunnel grafts that arestitched along a centerline to subdivide the lumens of each of them intosublumens.

As can be seen in FIG. 7 branch stent grafts (120, 122, 124, 126) extendthrough fenestration (20) and within at sublumens (110, 112, 114 and116), respectively. Branch stent grafts (120, 122, 124, 126) extend fromfenestration into renal arteries (90, 92), celiac artery (130), andsuperior mesenteric artery (128), respectively.

In another embodiment, the invention is a method for treating asuprarenal or thoracoabdominal aortic aneurysm. For example, withreference to FIGS. 6A, 6B and 7, stent graft is delivered through afemoral artery to aortic aneurysm site (84) of subject by radially andreleasably constraining stent graft at the distal end of a controlcatheter of a delivery device (not shown). The fenestration of the stentgraft is aligned at aneurysm site (84) with at least one branch artery(90, 92, 128, 130) at the aneurysm site (84), and then the stent graftis released from the delivery device and the delivery device is removedfrom the subject. Each of at least one branch stent graft is releasablyconstrained by a branch delivery device. Each branch stent graft (120,122, 124, 126) is delivered by a respective branch delivery devicethrough a lumen of a tunnel graft of the stent graft and then throughfenestration (20) to aneurysm site (84). Branch stent grafts (120, 122,124, 126) extending from fenestration (20) are directed by therespective branch delivery device into a branch of the aorta at aneurysmsite (84), and secured in a respective proximal or distal tunnel graftlumen at one end and within the branch artery at the opposite end. Eachbranch stent graft is then released from the respective delivery device,which is then removed, thereby completing implantation and treating thesuprarenal or thoracoabdominal aortic aneurysm.

Vascular repair devices of the invention can be implanted, for example,by transfemoral access. Additional vascular repair devices that aredirected into the vascular repair devices of the invention can beimplanted, for example, by supraaortic vessel access (e.g., through thebrachial artery), or by transfemoral access or access from some otherbranch or branches of major blood vessels, including peripheral bloodvessels.

The relevant teachings of all patents, published applications andreferences cited herein are incorporated by reference in their entirety.The relevant teachings of U.S. Pat. Nos. 8,292,943; 7,763,063;8,308,790; 8,070,790; 8,740,963; 8,007,605; 9,320,631; 8,062,349;9,198,786; 8,062,345; 9,561,124; 9,173,755; 8,449,595; 8,636,788;9,333,104; 9,408,734; 9,408,735; 8,500,792; 9,220,617; 9,364,314;9,101,506; 8,998,970; 9,554,929; 9,439,751; 9,592,112 and 9,655,712;U.S. patent application Ser. Nos. 14/226,005; 14/575,673; 15/166,818;15/167,055; 14/272,818; 14/861,479; 15/478,424; 15/478,737 andPCT/US2017/025849 are also incorporated by reference in their entirety.

While this invention has been particularly shown and described withreferences to example embodiments thereof, it will be understood bythose skilled in the art that various changes in form and details may bemade therein without departing from the scope of the inventionencompassed by the appended claims.

What is claimed is:
 1. A stent graft (10) comprising: a) a tubularaortic component (12) defining a lumen having a proximal end (14), adistal end (16), a major longitudinal axis (18), and defining afenestration (20) between the proximal end (14) and the distal end (16);b) a pocket (38) at the fenestration, the pocket defining a pocketproximal opening (40) and a pocket distal opening (42) opposite thepocket proximal opening (40) within the lumen; c) at least one proximaltunnel graft (44) having a proximal tunnel graft proximal end (46) and aproximal tunnel graft distal end (48), and defining at least oneproximal tunnel graft lumen (50), the proximal tunnel graft extendingproximally within the lumen from the proximal opening of the pocket, andbeing secured at its proximal end to the tubular aortic component (12);and d) at least one distal tunnel graft (52) having a distal tunnelgraft proximal end (54) and a distal tunnel graft distal end (56), anddefining at least one distal tunnel graft lumen (58), the distal tunnelgraft extending distally within the lumen from the distal opening of thepocket, and being secured at its distal end to the tubular aorticcomponent (12).
 2. The stent graft of claim 1, wherein the distal end ofthe tubular aortic component (12) is bifurcated (82), thereby definingtwo legs of the stent graft.
 3. The stent graft of claim 1, wherein thefenestration (20) defines a fenestration proximal end (22) that lies ina plane orthogonal to the major longitudinal axis (18) of the tubularaortic component (12).
 4. The stent graft of claim 1, wherein thefenestration (20) defines a fenestration distal end (24) that lies in aplane orthogonal to the major longitudinal axis (18) of the tubularaortic component (12).
 5. The stent graft of claim 1, wherein thefenestration defines at least one of a fenestration proximal end (22)and a fenestration distal end (24) that lies in a plane orthogonal tothe major longitudinal axis (18) of the tubular aortic component (12).6. The stent graft of claim 5, wherein at least one of the fenestrationproximal end (22) and the fenestration distal end (24) of thefenestration (20) lying in the plane orthogonal to the majorlongitudinal axis has a length greater than that of at least one of: thetotal diameter of the distal end of the at least one proximal tunnelgraft (44); and the total diameter of the proximal end of the at leastone distal tunnel graft (52).
 7. The stent graft of claim 1, wherein theproximal end of the at least one proximal tunnel graft and the distalend of at least one of the at least one distal tunnel graft defines aflared opening.
 8. The stent graft of claim 7, further including atleast one stent (67, 77) supporting the flared opening of at least oneof the proximal tunnel graft proximal end (46) and at least one of thedistal tunnel graft distal end (56).
 9. The stent graft of claim 7,wherein the proximal tunnel graft proximal end (66) defines a flaredopening (67).
 10. The stent graft of claim 7, wherein the distal tunnelgraft distal end (72) defines a flared opening.
 11. The stent graft ofclaim 10, further including at least one stent supporting the distaltunnel graft (70) and the proximal tunnel graft (64).
 12. The stentgraft of claim 8, wherein both the distal tunnel graft distal end (72)and the proximal tunnel graft proximal end (66) define, respectively, aflared opening.
 13. The stent graft of claim 1, further including a barestent (28) having proximal apices and distal apices, the bare stent (28)affixed to the proximal end (14) of the tubular aortic component (12) atthe distal apices and wherein the proximal apices extend proximallybeyond the proximal end (14) of the tubular aortic component (12). 14.The stent graft of claim 1, further including at least two branch stentgrafts, each branch stent graft extending through the fenestration (20)and within at least one of the proximal tunnel graft lumen and thedistal tunnel graft lumen.
 15. The stent graft of claim 14, furtherincluding at least two branch stent grafts, wherein the at least twobranch stent grafts each extend through the fenestration, and wherein atleast one of the branch stent grafts extends through one of the proximaltunnel graft lumen and the distal tunnel graft lumen.
 16. The stentgraft of claim 1, wherein at least one of the proximal tunnel graft andthe distal tunnel graft includes a septum (106, 108) that partitions atleast one of the proximal tunnel graft lumen and the distal tunnel graftlumen into two sublumens, each sublumen having a proximal end and adistal end.
 17. The stent graft of claim 16, including a plurality ofseptums, wherein one septum partitions the proximal tunnel graft lumeninto two lumens and one septum partitions the distal tunnel graft lumeninto two sublumens.
 18. The stent graft of claim 16, further includingat least two branch stent grafts, each branch stent graft extendingthrough the fenestration and within one of the two sublumens of theproximal tunnel graft.
 19. The stent graft of claim 16, furtherincluding at least two branch stent grafts, each extending through thefenestration and each, independently, extending within one of thesublumens of the distal tunnel graft.
 20. The stent graft of claim 16,wherein both of the proximal tunnel graft and the distal tunnel graft issupported by a stent graft.
 21. The stent graft of claim 20, whereineach septum partitions the proximal and distal tunnel graft lumens intotwo sublumens to a point proximal to the flared distal opening of thedistal tunnel graft or distal to the flared proximal opening of theproximal tunnel graft lumen.
 22. The stent graft of claim 20, furtherincluding four branch stent grafts, all of which extend through thefenestration, and each of which extends independently within one of thesublumens.
 23. A method for treating a suprarenal or thoracoabdominalaortic aneurysm, comprising the steps of: a) delivering a stent graftthrough an aorta (83) to an aneurysm site (84) of a patient, the stentgraft being radially and releasably constrained by a delivery device,the stent graft including: i) a tubular aortic component (12) having aproximal end, a distal end, and a major longitudinal axis, and defininga lumen, and defining a fenestration between the proximal end and thedistal end; ii) a pocket at the fenestration and within the lumen, thepocket defining a proximal opening and a distal opening opposite theproximal opening; iii) at least one proximal tunnel graft defining aproximal tunnel graft proximal end and a proximal tunnel graft distalend, the proximal tunnel graft extending proximally within the lumenfrom the proximal opening of the pocket, and being secured at itsproximal end to the tubular aortic component (12); and iv) at least onedistal tunnel graft having a distal tunnel graft proximal end anddefining a distal tunnel graft distal end, the distal tunnel graftextending distally within the lumen from the distal opening of thepocket, and being secured at its distal end to the tubular aorticcomponent (12). b) aligning the fenestration at the aneurysm site (84)of the patient with at least one branch of the aorta at the aneurysmsite; c) releasing the stent graft from the delivery device; d)delivering at least one branch stent graft through the distal end of thestent graft through the distal tunnel graft lumen to the fenestration,and through the fenestration to a branch of the aorta at the aneurysmsite, whereby the branch stent graft is radially and releasablyconstrained by a first branch delivery device; e) releasing the branchstent graft from the first branch delivery device; f) retracting thefirst branch delivery device; g) delivering at least one branch stentgraft through the proximal end of the stent graft through the proximaltunnel graft lumen to the fenestration, and through the fenestration toa branch of the aorta at the aneurysm site, whereby the branch stentgraft is radially and releasably constrained by a second branch deliverydevice; h) releasing the branch stent graft from the second branchdelivery device; and i) retracting the second branch delivery device,thereby treating the suprarenal or thoracoabdominal aortic aneurysm.